The Brain Radiation Plan

October 24, 2018

I had an appointment with the Radiation Oncologist for my brain today. The plan is to radiate the 2nd tumor. She’ll be talking with my Oncologist about the targeted chemo to make sure that it’s crossing the blood/brain barrier and killing the microscopic disease in the tumor bed where the 4 cm tumor was removed because right now, it’s still too dangerous to radiate that bed. This is in part because the tumors are so close together – they’re barely a cm (about half an inch) apart, and she doesn’t want to treat too much of my healthy brain tissue if she can avoid it. If the Kadcyla doesn’t cross the blood/brain barrier, there are a couple of other chemo treatments that have worked with other people with metastatic brain cancer that we’ll be using instead.

There were 3 options on the table – one is Stereotactic Surgery, which would be a single, high dose of radiation to the tumor. The other is to use a lower dose to treat the tumor over 3-5 treatments. Lastly, whole brain radiation was another option, but one I don’t want to have at this point. The whole brain radiation causes problems similar to chemo brain. I can’t really afford any more cognitive issues at this point. It’s been hard enough to work and stay focused as it is. We’ll save that one as a nuclear option for later if I need it.

The planning for this radiation treatment is pretty similar to the planning for the breast treatment. I will have scans done, the physicist will come up with a plan for radiating the tumor, there will be a dry run and then 3-5 days of treatment. I’ll have a follow-up scan in 30 days to see if the radiation worked, and then MRIs every 3 months after that.

Over the next 30 days or so, she’ll also be monitoring the size of the tumor bed from the one that was removed. The hope is that it will shrink some and she’ll be able to radiate it at a later date. I’m also hoping this is the case. The rate of recurrence is pretty high, but one of the more promising things she said today was that she has much more control and success in radiating any new growths – when they’re only a few mm in size – as opposed to when they’ve had a chance to grow bigger. When they get to be large tumors, there is a lot more healthy tissue to work around and protect.

Guess I’ll be sporting a radiation bald spot for a while.

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What to Eat – Sheet Pan Chicken Parmesan

Sheet Pan Chicken Parmesan

I think one of the best investments I’ve ever made is this quarter’s Taste of Home One Pan Dinners magazine.

What I liked about this recipe was that it was fast and easy. I had a bag of broccoli and cauliflower in the fridge that I wanted and needed to use, so I pulled that out and used both instead of just the broccoli. The veggies got mushier than I would have liked, but they were still okay. I also would have liked more flavor to the chicken itself, but that’s a trade-off when you make something quick like this anyway.

I had more chicken breasts than the recipe called for, so I also ended up using a full jar of red sauce. The first night, I ate this with mashed potatoes. The 2nd night with noodles. Thinking about using my spaghetti squash “noodles” for at least one of the remaining leftovers.

Ingredients

  • 1 large egg
  • 1/2 cup panko (Japanese) bread crumbs
  • 1/2 cup grated Parmesan cheese
  • 1/2 teaspoon salt
  • 1 teaspoon pepper
  • 1 teaspoon garlic powder
  • 4 boneless skinless chicken breast halves (6 ounces each)
  • Olive oil-flavored cooking spray
  • 4 cups fresh or frozen broccoli florets (about 10 ounces)
  • 1 cup marinara sauce
  • 1 cup shredded mozzarella cheese
  • 1/4 cup minced fresh basil, optional

Directions

  • Preheat oven to 400°. Lightly coat a 15x10x1-in. baking pan with cooking spray.
  • In a shallow bowl, whisk egg. In a separate shallow bowl, stir together the next five ingredients. Dip chicken breast in egg; allow excess to drip off. Then dip in crumb mixture, patting to help coating adhere. Repeat with remaining chicken. Place chicken breasts in center third of baking pan. Spritz with cooking spray.
  • Bake 10 minutes. Remove from oven. Spread broccoli in a single layer along both sides of sheet pan (if broccoli is frozen, break pieces apart). Return to oven; bake 10 minutes longer. Remove from oven.
  • Preheat broiler. Spread marinara sauce over chicken; top with shredded cheese. Broil chicken and broccoli 3-4 in. from heat until cheese is golden brown and vegetables are tender, 3-5 minutes. If desired, sprinkle with basil.

Test Kitchen tips

  • Try serving this on a bed of riced cauliflower. A number of brands are available in the vegetable section of the freezer case.
  • Like most Italian-inspired dishes, this would pair wonderfully with a thick slice of garlic bread.

Nutrition Facts

1 serving: 504 calories, 17g fat (7g saturated fat), 147mg cholesterol, 1151mg sodium, 27g carbohydrate (10g sugars, 8g fiber), 52g protein.

Originally published as Sheet Pan Chicken Parmesan in Taste of Home Feb/Mar 2018
Posted in Food/Drink, The Not Cancer Part | Tagged , , , , , , ,

What to Eat – Pan-Roasted Chicken and Vegetables

Pan-Roasted Chicken and Vegetables

This is another recipe from the Taste of Home One Pan Meals magazine. I liked its simplicity. If you don’t want the spinach, you could substitute carrots, broccoli, or cauliflower instead. If you’re looking for more iron and protein, swap it out for kale and add some garlic to it.

Ingredients

  • 2 pounds red potatoes (about 6 medium), cut into 3/4-inch pieces
  • 1 large onion, coarsely chopped
  • 2 tablespoons olive oil
  • 3 garlic cloves, minced
  • 1-1/4 teaspoons salt, divided
  • 1 teaspoon dried rosemary, crushed, divided
  • 3/4 teaspoon pepper, divided
  • 1/2 teaspoon paprika
  • 6 bone-in chicken thighs (about 2-1/4 pounds), skin removed
  • 6 cups fresh baby spinach (about 6 ounces)

Directions

  • Preheat oven to 425°. In a large bowl, combine potatoes, onion, oil, garlic, 3/4 teaspoon salt, 1/2 teaspoon rosemary and 1/2 teaspoon pepper; toss to coat. Transfer to a 15x10x1-in. baking pan coated with cooking spray.
  • In a small bowl, mix paprika and the remaining salt, rosemary and pepper. Sprinkle chicken with paprika mixture; arrange over vegetables. Roast until a thermometer inserted in chicken reads 170°-175° and vegetables are just tender, 35-40 minutes.
  • Remove chicken to a serving platter; keep warm. Top vegetables with spinach. Roast until vegetables are tender and spinach is wilted, 8-10 minutes longer. Stir vegetables to combine; serve with chicken.

Test Kitchen tips

Prepare the sheet tray the night before and just pop it into the preheated oven to bake. This helps to deeply flavor the chicken. A win win!

  • If you want a richer dish, use skin-on chicken, and if you want a lighter dish, use bone-in chicken breasts. Be sure to cook bone-in breasts just to 165-170 degrees, since leaner meat can become dry at higher temperatures.

Nutrition Facts

1 chicken thigh with 1 cup vegetables: 357 calories, 14g fat (3g saturated fat), 87mg cholesterol, 597mg sodium, 28g carbohydrate (3g sugars, 4g fiber), 28g protein. Diabetic Exchanges: 4 lean meat, 1-1/2 starch, 1 vegetable, 1 fat.

Posted in Food/Drink, The Not Cancer Part | Tagged , , , , , , , , , , , , , , , , ,

January 2019

Hi all, I haven’t posted anything in a while because the neuropathy in my hands has gotten so bad that I can’t feel where I am on the keyboard, and when I can get lined up, my fingers hurt after just a few minutes.

I am looking at some voice-to-text options and hope to be back soon.

 

Posted in Uncategorized

Brain Radiation

November 1, 2018

I had to have a new MRI and a CT scan on my head in the past week to do radiation planning. On Tuesday, they did a run through of the plan and I got my first treatment on the 2nd tumor. I had one treatment per day for a total of 3 treatments.

I’ll have a follow-up MRI in a month. The first thing they’ll look at is the size of the 2nd tumor to make sure it’s shrinking and not growing. Then, they’ll be checking the size of the tumor bed from the one that was removed and, hopefully, it will have shrunk some, or maybe enough to do the radiation on it as well. If not, we’ll check it again in 3 months and hopefully be able to radiate it at that point. The reason for this is that there are still likely microscopic cancer cells where the tumor was removed. Radiation kills those cells so that the rate of recurrence in that same spot goes down to some minuscule amount.

I was not looking forward to doing this radiation. There is a part of me that would have rather had this tumor surgically removed. Unfortunately, the risk of more complications and the possibility of blindness were enough to warrant taking a less risky path, which meant doing lower dose radiation over a few days rather than a single-shot Stereotactic radiosurgery (SRS) to the 2nd tumor. There is also a big risk of radiating the tumor bed where the 1st tumor was removed for now. It was a big tumor. The Brain Radiation Oncologist explained to me that when the tumors are as close together as mine were, and the size that they were, there’s a bigger risk to damaging healthy brain tissue, which would also lead to other vision and brain issues. So the plan is to radiate the 2nd tumor with a lower dose plan now and see where we are in a month or three with the tumor bed, and hopefully get it radiated at a later date.

How Brain Radiation Works

To do radiation on your brain, they make a tight-fitting mesh plastic mask that fits over the head and face. The point of the mask is tri-fold. First, to make sure that you are in exactly the same position for each treatment, make sure you don’t move, and to have a place to put the markings for the machine to ensure you’re lined up correctly each time. When I had the breast radiation just a couple of months ago, I got a handful of pinpoint tattoos on my skin where the lasers would line up. They don’t want to tattoo your head or face, so they put those markings on the mask instead. Thank goodness for that. I am not interested in looking like a Maori warrior, even though I think they look kind of cool. Or maybe I should contemplate that. Why not? I’ve got nothing to lose.

When I went in for my breast radiation, there were 3 radiation plans to run through. For my brain tumor, I had 6 plans. The first one went from one side to the other across my face. The next 3 went from front to back and then to front again. The last 2 were more on a diagonal and also went front to back and then to front again. The process took about 30-45 minutes despite each plan taking anywhere from about 20 seconds to maybe a minute for the longest one. First are the x-rays to make sure you’re in the right position. Then, in between plans, the technicians come in and move the table between each one. I was rotated on the table 3 times during these sessions.

The Brain Radiation Experience

Laying on a radiation table with a really tight-fitting mesh plastic mask over my face and head wasn’t any fun. I’m not horribly claustrophobic, but this sucked. In order to get through it, I reminded myself it was only 3 treatments and not 3 weeks’ worth. I asked the technician to cut holes for my eyes, nose and mouth. I didn’t realize until I was clamped down tight for the first verification test that I wasn’t going to be able to breathe at all through my mouth during these sessions. Guess I could have passed on that part. Fortunately, I had them make sure I could breathe through my nose, and I was able to relax enough to get through the 3 sessions.

Brain Radiation Complete

I’m glad to be done with this. I am hoping that the treatment works the way it’s supposed to and the tumor starts to shrink and I get some more of my vision back. In a perfect world, I’ll wake up one morning a couple of months from now and notice that I can see pretty much like I did before all this started. That’s my pipedream. Whether I ever get that or not remains to be seen. Of all the cells in your body, the brain is the slowest to generate new cells, and when it either makes new ones or repairs old ones, they’re the slowest growing cells we’ve got. So… that means that it could be more than a few months before I’m at a stable enough vision point to get new glasses again. One step and one thing at a time.

From here, I need to pay attention to radiation side effects. I’m to watch for neurological changes, nausea, balance issues, and headaches. I will start ramping down the steroids tomorrow. Hopefully, I’ll be done with them in a month’s time. The side effects from the steroids are impacting my vision and appetite, too. Last, but not least, to add to my already wonderful Neuro hairstyle, I’ll have a bald spot for a bit where my head was just radiated. This, of course, is the very least of my worries. I know it’ll grow back. It’ll be interesting to see what pattern falls out.

For the next 3 weeks or so, I’m focusing on resting and healing. I’ve taken a leave from work. After tomorrow, I’m not beholden to anyone at the hospital for a bit. That will be a welcome change. I’m tired of racing from appointment to appointment, some of them between hospital campuses across the city getting ready for this treatment. Enough is enough for a while. I need a break.

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60-Days Post-Cisplatin (Chemo)

October 24, 2018

I’m 60 days post-Cisplatin today. Some of the side effects of this chemo are finally starting to lessen a bit.

The neuropathy comes and goes. Mostly it stays, but I can feel it waning some. There are days when my feet and fingers are still more or less numb, and days when it feels more like when we were kids and had stayed out in the snow too long. Our fingers and toes would be numb for a bit, then they’d burn some and then just get kind of tingly as they warmed up and feeling came back. These days, the tingly wins over the numb more often than not. When my sister was here, I told her it kind of felt like having slippers on inside your feet and fingers. She said she didn’t think she could handle that. It is a bit of a strange sensation sometimes. There are days when being numb felt better, but I don’t want to go back to that.  The thing that bugs me most is having my fingers on the wrong keys when I’m trying to type. I can’t feel the little bumps on the keys that tell me where home row is on my laptop. Hopefully, all of this will go away eventually.

I started noticing this week that the ringing in my ears is starting to get a little less loud, which is another good thing to be happening. I’ll be getting another audiogram at the end of the month or the beginning of December to make sure there is no permanent damage to my hearing. I think that because I’m noticing it decreasing, that it won’t be a permanent thing.

Food is also finally starting to taste a little better, too. Cisplatin ruined pretty much everything food-wise. It was getting to the point where I didn’t want to eat at all because it literally tainted almost every single thing I ate or drank. Even some of the stuff I could tolerate on the AC chemo tasted awful on Cisplatin. There were one or two things that were passable, but that was about it. I’m hoping that the Cisplatin will be out of my system in the next couple of months and a lot of these side effects will be a thing of my past.

The last substantial side effect of Cisplatin was pretty much going back to square one with chemobrain. Looking back at my post 3-months after finishing AC and Taxol, I was just starting to get pieces of my memory back. I’m not that far out from Cisplatin yet, so I’m hoping things will continue to improve for the next month and that I’m done with regular chemos for a long, long time.

I’m still struggling with finding words and things that are time bound. I’m forgetting what I was going to say mid-sentence. I’ve got calendar reminders for my calendar reminders. I’ve got lists of lists. This is how chemo brain still impacts my life almost a year after noticing it in the first place. This time, though, I will finally get to see the Neuropsychologist at the end of November to do testing and start more Occupational Therapy to work around the damage the chemo’s done to my short-term memory. I don’t know if my memory will ever get back to normal. That’s something that gets hard for me. I never ever had memory issues like this before. Now, I feel like my brain’s been taken over by aliens. I don’t like the idea that I don’t get to know when the aliens will move out and give me my brain back.

 

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1st Day of Kadcyla

October 12, 2018

I got my first dose of Kadcyla today. It’s another targeted chemotherapy drug that is supposed to stop the cancer from growing and spreading. The previous two targeted chemotherapy drugs, Herceptin and Perjeta, clearly weren’t working for me. I’ll have this one every 3 weeks, just like the other two. I’ll have new CT and bone scans in December to make sure that it’s doing its job. If it’s not, we move to the next drug(s) in the line.

Whenever starting a new chemo drug, the protocol is to give it at about half the rate that it would normally be given in case there is a reaction to any part of it. Today’s dose took about an hour and a half. The Oncologist said that they would normally want to watch me for 90 minutes after, too, but because this is so similar to the Herceptin, she’d leave that up to them. Thankfully, there wasn’t an issue with it and they let me go home after it finished around 1:00 pm.

Kadcyla is essentially the same drug as Herceptin except that instead of  just blocking a growth signal, it delivers a chemo to the cells directly to kill them rather than just keep them from growing any larger. The side effects, then, are more from the chemo it’s delivering than from the part that attaches itself to the cancer stem cells. I’m a little skeptical about this one because it’s a derivative of Herceptin. We don’t know why that didn’t work. Whether it was Herceptin not finding the cells and doing its thing or if my immune system is standing in its way or something else.

Because Kadcyla carries an actual chemo with it, I’ll have to go in for blood work every 3 weeks again, continue with quarterly echocardiograms and keep an eye on any bleeding problems like excessive bruising and bloody noses. I’ve tolerated most of these chemo drugs pretty well in the past. I am hoping and praying that this one doesn’t “break the camel’s back” so to speak, and start me down a road of dealing with whatever issues chemo’s done to me.

I also had a meeting with one of the social workers today. I don’t recall off the top of my head if she’s one of those associated with the palliative care doctor or not. It doesn’t really matter. One of them mentioned that I could get taxi vouchers to get a ride home, so instead of spending $45 on a Lyft ride myself, I went back and asked for a taxi voucher. Getting the cab wasn’t that difficult or much more time consuming than requesting a Lyft. Interestingly enough, it was more expensive than the Lyft ride, and I didn’t feel all that safe heading home. The taxi driver took 5 or 6 personal calls on his cell phone the entire way home. I’ve not had a single Lyft driver yet take a call while doing a drive. I’m hoping that the program between the American Cancer Society and Lyft where they provide free rides to cancer patients gets to Seattle soon. They’re just so much more convenient than screwing with volunteers and vouchers.

 

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